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A Natural Formula for Success

With nowhere to turn for help, many women who want to breast-feed give up on it early, experts say. Now, some hospitals, consultants and even employers are trying to make it easier for new moms to get support.


When Melody Wolfgram gave birth to her first and only child at 36, she was determined to do everything right, including breast-feed. She'd read the literature and knew how important it was for her baby's health. But what followed were two of the most stressful weeks of her life.

"I was a basket case. My breasts were hard and very painful. No milk was coming out. My baby was crying because she wasn't satisfied. I was tired from being up half the night with a newborn, recovering from a C-section and hormonal."

A hospital lactation consultant saw her once during her four-day stay and talked to her once at home on the phone.

"She kept telling me to go ahead and formula feed and pump after each feeding, which was pointless, because no milk came out," Wolfgram said.

Nonetheless, Wolfgram stuck with the unsuccessful--often tearful--feeding routine for two weeks, until finally, her mother and husband convinced her to give it a rest. Reluctantly, the San Juan Capistrano mother committed to formula but felt for a long time that she had somehow failed this important first step of motherhood.

Across the nation, the number of women who begin breast-feeding has more than doubled in the last three decades, from 25% in 1970 to 58% in 1994, according to the National Center for Health Statistics. That number may be as high as 64% today, estimates Ross Laboratories, a leading formula manufacturer.

However, like Wolfgram, almost half of those who start are no longer breast-feeding three months later.

Most of the drop-off occurs in the first weeks. One 1994 survey found that 73% of women in California who started breast-feeding when their baby was born had stopped within nine weeks. The survey was conducted by the Pregnancy Risk Assessment Monitoring System in cooperation with the national Centers for Disease Control and Prevention.

"Most women recognize that breast is best, but they aren't receiving adequate support to continue breast-feeding," said Julie Gazmararian, a health researcher with Aetna US Healthcare.

Gazmararian and a colleague reported in the May-June issue of the journal of Effective Clinical Practice on how education and support tie into the decision to breast-feed. They found that although education about breast-feeding during pregnancy was important, postpartum support was more critical to success yet far less commonplace.

"New mothers have few places to turn because breast-feeding has become a lost art in our country," said Corky Harvey, a lactation consultant and co-owner of the Pump Station in Santa Monica. "Our culture doesn't support it the way other cultures do. Many of today's mothers weren't breast-fed themselves. They have no role models. The family infrastructure of support that is prevalent in other countries where female elders help new moms doesn't exist here."

Doctors don't get much training on the subject, so they often aren't much help, leaving women to figure it out on their own.

"Often when I go to parties and people ask me what I do, the next thing they say is, 'I wish you'd been around when I needed you,' " said Harvey. Although more help is available than even five or 10 years ago--thanks to more hospital-based programs, accommodations in the workplace, better pumping products and the Internet--experts say we still have a long way to go.

Better support, said Debora Edmunds, the Los Angeles representative for Medela, the leading supplier of lactation equipment, was exactly what Wolfgram needed, and many other postpartum women need but have difficulty finding.

"She needed someone to sit with her, warm compresses to relieve her engorgement, soft music and more rest. Like a lot of moms, she was uptight and unsure," said Edmunds, who believes that with the right assistance Wolfgram could have had a better experience.

Although Wolfgram isn't convinced such help would have made her breast-feeding successful, she knows it would have made a difficult situation easier.

"It would be nice to talk this through with someone knowledgeable who could say, 'If this doesn't work out, here's our game plan.' If I'd been better prepared for what could go wrong, I would have been better prepared emotionally for the disappointment."

Personal Choices Amid Public Changes

In 1997, the American Academy of Pediatrics came out with a strongly worded endorsement for breast-feeding and a policy statement recommending that women begin breast-feeding within an hour of birth and continue "as long as mutually desired" until the baby is at least 12 months old or older.

Studies have shown that breast-fed babies have fewer ear and other infections the first year of life, have a reduced chance of developing asthma and allergies, and bond more readily with their mothers. Breast milk is also custom formulated and chemically changes to meet the changing needs of a baby in a way that can't be reproduced in a laboratory.

Although most women are capable of breast-feeding, there are often personal reasons for not doing so.

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